About healthcare reform

Key Points

After nearly a year of intense negotiations, the Patient Protection and Affordable Care Act-better known as healthcare reform-has become law. The question you're probably asking now is: "What does this mean for me, my practice, and my patients?"

The major focus of the law, and the one with the most potential for immediate impact on your practice, is to begin providing some form of health insurance to millions of Americans who don't now have it. It does this through provisions such as:

INCREASED REIMBURSEMENTS FROM MEDICARE AND MEDICAID-TEMPORARILY

"There are patients right now who will try to find a primary care doctor and find all the practices in their area are closed [to new patients], and the situation is only going to get worse," says Lori Heim, MD, president of the American Academy of Family Physicians (AAFP).

While organizations representing primary care doctors say the legislation is far from perfect, they generally support some aspects of it.

"Our members are affected when any of their patients lose insurance, because then they have to scramble to try and find them care," says the AAFP's Heim. "So for every family doctor with a patient who's been dropped from coverage after losing a job or being diagnosed with a serious illness, this is a big step forward."

Shawn Martin, director of government relations for the American Osteopathic Association, says, "We were really pleased with the emphasis put on primary care and the continuous and comprehensive relationship with the primary care provider." The reforms will strain the nation's primary care delivery system, he adds, but "there are ways of dealing with that."

Eliminating the co-pay for annual wellness visits under Medicare, and for preventive services under Medicare and private insurance, should help primary care practices' bottom line, says Dean Smith, PhD, professor and senior associate dean of the University of Michigan's School of Public Health.

"From a financial standpoint, it means physicians will have a higher percentage of their patients who have coverage for services, and the coverage will pay them more than they were previously receiving," he says. He says the provision also will ease practices' collection burdens, because fewer patient visits will require co-pays.

Although the co-pay elimination and other provisions of the legislation are designed to emphasize the importance of preventive care, their effect on patient volume is an open question. Healthcare economists have shown that a 10 percent reduction in patient costs generally results in a 2 percent to 3 percent increase in the number of visits. But dropping the co-pay will make certain types of visits free for those with Medicare or private insurance, and "we don't know what the effect of 'free' is on healthcare services," Smith says.